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  • Letter to the Editor
  • Daniel S. Blumenthal, MD, MPH , Professor and Chair

To the Editor:

Norcini, Zanten, and Boulet1 make the point that international medical graduates contribute to the diversity of the U.S. physician workforce. Unfortunately, they do not contribute the sort of diversity that is needed.

According to Norcini et al., 4.3% of IMGs in residencies and fellowships are Black and 7.5% are Hispanic. This compares with 6.5% of recent U.S. medical graduates (USMGs) who are Black and 6.4% who are Hispanic.2 Hence, U.S. medical schools contribute more than do foreign schools to the Black U.S. physician workforce, and contribute to the U.S. Hispanic physician workforce at about the same rate as foreign schools.

The data of Norcini et al. demonstrate that the major contribution of IMGs to diversity in the U.S. physician workforce is in the Asian component of that workforce: 37.2% of IMG residents and fellows are Asian. This is more than the 20% of recent USMGs who are Asian.2 However, Asian physicians (unlike Black and Hispanic physicians) are already well-represented in the U.S. physician workforce: 5.7% of the current U.S. physician workforce is Asian, compared with 3.9% of the U.S. population.3

Norcini and colleagues correctly point out that the U.S. medical school expansion currently underway, combined with the cap on residency positions, will “have the effect of reducing the number of IMGs who train and practice in the U.S.”1, p. 498 However, it appears that this would have no adverse effect on the proportion of the U.S. physician workforce that is Black or Hispanic. To increase the percentage of these ethnic groups in the U.S. physician workforce, U.S. medical schools must do a better job of recruiting and retaining Black and Hispanic students. They cannot look to foreign schools to do the job for them. [End Page xii]

Daniel S. Blumenthal, Professor and Chair
Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
The author is a member of JHCPU's editorial board.


1. Norcini JJ, van Zanten M, Boulet JR. The contribution of international medical graduates to diversity in the u.s. physician workforce: graduate medical education. J Health Care Poor Underserved. 2008;19:493–9.

2. Association of American Medical Colleges (AAMC). Minorities in medical education: facts and figures 2005. Washington, DC. Available at .

3. Association of American Medical Colleges (AAMC). Available at . Accessed May 26, 2008.



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